Health Insurance Exchange Offers 'Apples-To-Apples' -- Well Almost

A key tenet of the Affordable Care Act is that, when buying health insurance, customers should be able to easily compare benefits and costs.

Is an "apples to apples" comparison of health care insurance really possible?

Michael Clapp/OPB

The government calls it an “apples-to-apples” comparison.

Those setting up Oregon’s health care marketplace find that a true apples-to-apples comparison is hard to come by.

Oregon has more than half-a-million people who aren’t insured.

The state’s new health exchange, Cover Oregon, is hoping to sign up about a third of them in the first year.

Customers will go online and plug in information — like their income and family status. That way they’ll learn how much of a federal tax credit they’re likely to get.

Then they’ll plug in their age, smoking-habits and location.

Cover Oregon manager Damian Brayko says there will also be a series of questions, like: “Do you have an on-going medical condition?”

Family Care, an Oregon Coordinated Care Organization, is increasing its medicaid reimbursement rates after finding that good primary care saves money.

North Carolina Dept. of Agriculture

“What we try and do,” he said, “is take that huge universe of plans that is out there and narrow it down somewhat for you to take a look at.”

One way Oregon hopes people can whittle down their choice is by opting for one of the so called standard plans.

These are plans where 10 basic benefits are all covered. The plans are then split into four levels: bronze, silver, gold and platinum.

So in the bronze plan, for example, the customer pays 40 percent of any costs, while the insurance company pays 60 percent. For silver, it’s a 30-70 split. For gold, it’s a 20-80 split, and so on.

The trade-off, says Brayko, is how much you pay for a premium versus how much you pay when you get care.

“Someone with multiple chronic conditions is going to go in a lot,” he said. “Someone who is relatively healthy and may go in if they’ve get the flu, or they just need some sporadic care, it’s a very different decision process.”

So, once a customer has picked a level, they’ll choose among companies like PacificSource, Kaiser or LifeWise — and the price will be right there.

The federal government says insurance companies must provide an “apples-to-apples comparison.” But Brayko said, Oregon isn’t quite there, “I think what we’re trying to do is get closer to apples-to-apples.”

The Cover Oregon website.

He said all the benefits in the standard plans are the same, as are the co-pays, and the deductibles. But things like the cost of a doctor visit will vary slightly.

“In the past, you may have been looking at a mixed fruit basket,” he said. “And now at least you’re looking at a couple of different varieties of apples. Maybe it’s a Gravenstein and a Macintosh. But at least they’re in the apple family.”

Cover Oregon has released some rates.

Take the cheapest plan — the standard bronze level — for a 40-year-old, single, non-smoker from Portland.

The price with Trillium is $271-a-month. At Moda it’s $166-a-month. That’s a big difference. But someone might pick the more expensive plan to stay with a favorite doctor.

It can get confusing, so Cover Oregon has granted more than $3 million to 30 community organizations to help families enroll.

Brayko said people who want help enrolling should contact a community group or insurance agent, “There’s no cost to have an insurance agent, there’s no cost to have a navigator or community partner help you out with these things.”

JR Hinds is an agent in Portland. He says the exchange is an exciting opportunity for small businesses to offer employees a variety of plans — rather than just one or two. But he’s worried the standard plans might turn health insurance into more of a commodity.

“Carriers will probably have to strip out some value in order to compete on their price,” he said. “And I think that’s one area where I’ll be wary of, making sure the carriers aren’t cutting their networks too much.”

OHSU president, Joe Robertson.

Kristian Foden-Vencil/OPB

Having more people insured is likely to result in more preventive care and fewer hospital admissions. But the president of Oregon Health and Science University, Joe Robertson, says they’re not worried about that.

“We don’t know exactly how this is going to transpire,” he said. “But it’s exciting to be in Oregon because this is where the change will happen first, and health care reform is inevitable. I think that is one thing that everyone in this country agrees on.”

Cover Oregon has scheduled a teleconference Wednesday to announce further details on its launch.